16-003709/AABS v Unifund Assurance Company

Jan 10, 2018

Adjudicator: Catherine Bickley

The applicant was involved in an automobile accident on June 10, 2015, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (“Schedule”). The respondent, Unifund Assurance Company, paid the applicant income replacement benefits (“IRBs”) until December 9, 2015 when it denied further IRBs based on a number of s.44 examinations. In January 2016, the respondent also told the applicant that she was no longer entitled to Attendant Care Benefits. The issues were (1) whether the applicant is entitled to IRBs of $389.96 per week from December 10, 2015 to June 9, 2017; (2) whether the respondent is entitled to repayment of $2,984.59 plus interest in IRBs; and (3) whether the applicant is entitled to attendant care benefits.

Adjudicator Bickley ruled that (1) the applicant is not entitled to IRBs from December 10, 2015 to June 9, 2017; (2) the respondent is entitled to repayment of $2,984.59 plus interest in IRBs, and (3) the applicant is not entitled to attendant care benefits. Firstly, Adjudicator Bickley found that the applicant had not established that she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a result of the accident. The applicant’s lack of credibility on key issues made her testimony and medical reports unpersuasive. Instead, the Adjudicator relied on objective medical imaging that indicated significant findings were not caused by the accident but rather typical degenerative changes that come with aging. The applicant did not explain during her testimony how her injuries prevented her from performing the essential tasks of her job as a dental assistant. Finally, the applicant is not entitled to attendant care benefits because none were incurred as that term is defined in the Schedule.